Long-term Objective: To improve health outcomes of patients using small, rural hospitals and their associated ambulatory care facilities, long term care facilities, and home health agencies, by reducing the occurrences of preventable medical errors, through the use of information healthcare technology. Specific Aims: (1) Expand the existing web-based confidential medical error and "near miss" reporting system in rural West Virginia; (2) Monitor safety event reporting and offer concise, action oriented feedback; (3) Compare the event reports with surveillance from other sources, such as the claims-based AHRQ Patient Safety Indicators; (4) Develop a learning network among participating hospitals and change the focus of activities among collaborating hospitals from passive information sharing to active collaboration, using the experiences of hospital-based quality improvement projects and the IHI collaborative methodology; and (5) Build a business case for ongoing network operations and sustainability. [unreadable] [unreadable] Research Design and Methods: (1) lncrease the number of rural hospitals from 6 to 24 through education of the importance of project and through assistance with achieving up-to -date internet connectivity; (2) Collect and use event reporting through the use of a proven, web-based tool; (3) Compare the results from event reporting with indicators from claims data and identify sources and limitations of potential benchmarking data; (4) Apply IHI collaborative techniques to a collaboration of rural hospitals in West Virginia and work with patient safety leadership to identify priority areas for collaborative learning, and (5) Document benefits of the event reporting system and collaboration to hospitals, and present evidence that will measure the benefit of the reporting system as well as document costs associated with adverse events that are avoided as a consequence of successful operation of collaboratives and show the perceived value of learning networks to staff. [unreadable] [unreadable]